Alaska Medicaid 90 Day** Generic Prescription Medication List

Transcription

1 1 ACYCLOVIR 200 MG CAPSULE BUPROPION HCL 150 MG TAB ER 24H ACYCLOVIR 200 MG/5ML BUPROPION HCL 150 MG TABLET ER ACYCLOVIR 400 MG TABLET BUPROPION HCL 150 MG TABLET ER ACYCLOVIR 800 MG TABLET BUPROPION HCL 200 MG TABLET ER ALENDRONATE SODIUM 10 MG TABLET BUPROPION HCL 300 MG TAB ER 24H ALENDRONATE SODIUM 35 MG TABLET BUPROPION HCL 75 MG TABLET ALENDRONATE SODIUM 5 MG TABLET BUSPIRONE HCL 10 MG TABLET ALENDRONATE SODIUM 70 MG TABLET BUSPIRONE HCL 15 MG TABLET ALLOPURINOL 100 MG TABLET BUSPIRONE HCL 30 MG TABLET ALLOPURINOL 300 MG TABLET BUSPIRONE HCL 5 MG TABLET AMANTADINE HCL 100 MG CAPSULE CAPTOPRIL 100 MG TABLET AMANTADINE HCL 50 MG/5 ML SYRUP CAPTOPRIL 12.5 MG TABLET AMIODARONE HCL 200 MG TABLET CAPTOPRIL 25 MG TABLET AMITRIPTYLINE HCL 10 MG TABLET CAPTOPRIL 50 MG TABLET AMITRIPTYLINE HCL 100 MG TABLET CARBAMAZEPINE 100 MG CPMP 12HR AMITRIPTYLINE HCL 150 MG TABLET CARBAMAZEPINE 100 MG TAB CHEW AMITRIPTYLINE HCL 25 MG TABLET CARBAMAZEPINE 100 MG/5ML ORAL SUSP AMITRIPTYLINE HCL 50 MG TABLET CARBAMAZEPINE 200 MG CPMP 12HR AMITRIPTYLINE HCL 75 MG TABLET CARBAMAZEPINE 200 MG TAB ER 12H AMLODIPINE BESYLATE 10 MG TABLET CARBAMAZEPINE 200 MG TABLET AMLODIPINE BESYLATE 2.5 MG TABLET CARBAMAZEPINE 300 MG CPMP 12HR AMLODIPINE BESYLATE 5 MG TABLET CARBAMAZEPINE 400 MG TAB ER 12H ANASTROZOLE 1 MG TABLET CARBIDOPA/LEVODOPA 10MG-100MG TABLET ATENOLOL 100 MG TABLET CARBIDOPA/LEVODOPA 25MG-100MG TABLET ATENOLOL 25 MG TABLET CARBIDOPA/LEVODOPA 25MG-100MG TABLET ER ATENOLOL 50 MG TABLET CARBIDOPA/LEVODOPA 25MG-250MG TABLET ATENOLOL/CHLORTHALIDONE 100MG-25MG TABLET CARBIDOPA/LEVODOPA 50MG-200MG TABLET ER ATENOLOL/CHLORTHALIDONE 50 MG-25MG TABLET CARVEDILOL 12.5 MG TABLET ATORVASTATIN CALCIUM 10 MG TABLET CARVEDILOL 25 MG TABLET ATORVASTATIN CALCIUM 20 MG TABLET CARVEDILOL MG TABLET ATORVASTATIN CALCIUM 40 MG TABLET CARVEDILOL 6.25 MG TABLET ATORVASTATIN CALCIUM 80 MG TABLET CETIRIZINE HCL 1 MG/ML SOLUTION BACLOFEN 10 MG TABLET CETIRIZINE HCL 10 MG TABLET BACLOFEN 20 MG TABLET CETIRIZINE HCL 5 MG TAB CHEW BENAZEPRIL HCL 10 MG TABLET CETIRIZINE HCL 5 MG TABLET BENAZEPRIL HCL 20 MG TABLET CHLORTHALIDONE 25 MG TABLET BENAZEPRIL HCL 40 MG TABLET CHLORTHALIDONE 50 MG TABLET BENAZEPRIL HCL 5 MG TABLET CITALOPRAM HYDROBROMIDE 10 MG TABLET BENAZEPRIL/HYDROCHLOROTHIAZIDE MG TABLET CITALOPRAM HYDROBROMIDE 10 MG/5 ML SOLUTION BENAZEPRIL/HYDROCHLOROTHIAZIDE MG TABLET CITALOPRAM HYDROBROMIDE 20 MG TABLET BENAZEPRIL/HYDROCHLOROTHIAZIDE 20-25MG TABLET CITALOPRAM HYDROBROMIDE 40 MG TABLET BENAZEPRIL/HYDROCHLOROTHIAZIDE MG TABLET CLONIDINE HCL 0.1 MG TABLET BENZTROPINE MESYLATE 0.5 MG TABLET CLONIDINE HCL 0.2 MG TABLET BENZTROPINE MESYLATE 1 MG TABLET CLONIDINE HCL 0.3 MG TABLET BENZTROPINE MESYLATE 2 MG TABLET CLOPIDOGREL BISULFATE 75 MG TABLET BUMETANIDE 0.5 MG TABLET CONTRACEPTIVES - GENERICS ONLY - ALL ROUTES OF ADMIN.** BUMETANIDE 1 MG TABLET CYCLOBENZAPRINE HCL 10 MG TABLET BUMETANIDE 2 MG TABLET CYCLOBENZAPRINE HCL 5 MG TABLET BUPROPION HCL 100 MG TABLET DICLOFENAC POTASSIUM 50 MG TABLET BUPROPION HCL 100 MG TABLET ER DICLOFENAC SODIUM 100 MG TAB ER 24H

2 2 DICLOFENAC SODIUM 25 MG TABLET DR FEXOFENADINE HCL 60 MG TABLET DICLOFENAC SODIUM 50 MG TABLET DR FEXOFENADINE HCL 180 MG TABLET DICLOFENAC SODIUM 75 MG TABLET DR FINASTERIDE 5 MG TABLET DIGOXIN 125 MCG TABLET FLUOXETINE HCL 10 MG CAPSULE DIGOXIN 250 MCG TABLET FLUOXETINE HCL 10 MG TABLET DILTIAZEM HCL 120 MG CAP ER 24H FLUOXETINE HCL 20 MG CAPSULE DILTIAZEM HCL 120 MG CAP ER DEG FLUOXETINE HCL 40 MG CAPSULE DILTIAZEM HCL 120 MG CAPSULE ER FLUOXETINE 20 MG/5ML SOLUTION DILTIAZEM HCL 120 MG CAP ER 12H FOSINOPRIL SODIUM 10 MG TABLET DILTIAZEM HCL 120 MG TABLET FOSINOPRIL SODIUM 20 MG TABLET DILTIAZEM HCL 180 MG CAP ER 24H FOSINOPRIL SODIUM 40 MG TABLET DILTIAZEM HCL 180 MG CAP ER DEG FUROSEMIDE 20 MG TABLET DILTIAZEM HCL 180 MG CAPSULE ER FUROSEMIDE 40 MG TABLET DILTIAZEM HCL 240 MG CAP ER 24H FUROSEMIDE 80 MG TABLET DILTIAZEM HCL 240 MG CAP ER DEG GABAPENTIN 100 MG CAPSULE DILTIAZEM HCL 240 MG CAPSULE ER GABAPENTIN 300 MG CAPSULE DILTIAZEM HCL 30 MG TABLET GABAPENTIN 400 MG CAPSULE DILTIAZEM HCL 300 MG CAP ER 24H GABAPENTIN 600 MG TABLET DILTIAZEM HCL 300 MG CAPSULE ER GABAPENTIN 800 MG TABLET DILTIAZEM HCL 360 MG CAPSULE ER GEMFIBROZIL 600 MG TABLET DILTIAZEM HCL 420MG CAPSULE ER GLIMEPIRIDE 1 MG TABLET DILTIAZEM HCL 60 MG CAP ER 12H GLIMEPIRIDE 2 MG TABLET DILTIAZEM HCL 60 MG TABLET GLIMEPIRIDE 4 MG TABLET DILTIAZEM HCL 90 MG CAP ER 12H GLIPIZIDE 10 MG TAB ER 24 DILTIAZEM HCL 90 MG TABLET GLIPIZIDE 10 MG TABLET DIVALPROEX SODIUM 125 MG CAP SPRINK GLIPIZIDE 2.5 MG TAB ER 24 DIVALPROEX SODIUM 125 MG TABLET DR GLIPIZIDE 5 MG TAB ER 24 DIVALPROEX SODIUM 250 MG TAB ER 24H GLIPIZIDE 5 MG TABLET DIVALPROEX SODIUM 250 MG TABLET DR GLIPIZIDE/METFORMIN HCL MG TABLET DIVALPROEX SODIUM 500 MG TAB ER 24H GLIPIZIDE/METFORMIN HCL MG TABLET DIVALPROEX SODIUM 500 MG TABLET DR GLIPIZIDE/METFORMIN HCL 5 MG-500MG TABLET DONEPEZIL HCL 10 MG TABLET GLYBURIDE 1.25 MG TABLET DONEPEZIL HCL 5 MG TABLET GLYBURIDE 2.5 MG TABLET DOXAZOSIN MESYLATE 1 MG TABLET GLYBURIDE 5 MG TABLET DOXAZOSIN MESYLATE 2 MG TABLET GLYBURIDE,MICRONIZED 1.5 MG TABLET DOXAZOSIN MESYLATE 4 MG TABLET GLYBURIDE,MICRONIZED 3 MG TABLET DOXAZOSIN MESYLATE 8 MG TABLET GLYBURIDE,MICRONIZED 6 MG TABLET DOXEPIN HCL 10 MG CAPSULE GLYBURIDE/METFORMIN HCL MG TABLET DOXEPIN HCL 100 MG CAPSULE GLYBURIDE/METFORMIN HCL MG TABLET DOXEPIN HCL 25 MG CAPSULE GLYBURIDE/METFORMIN HCL 5 MG-500MG TABLET DOXEPIN HCL 50 MG CAPSULE GUANFACINE HCL 1 MG TABLET DOXEPIN HCL 75 MG CAPSULE GUANFACINE HCL 2 MG TABLET ENALAPRIL MALEATE 10 MG TABLET HYDRALAZINE HCL 10 MG TABLET ENALAPRIL MALEATE 2.5 MG TABLET HYDRALAZINE HCL 100 MG TABLET ENALAPRIL MALEATE 20 MG TABLET HYDRALAZINE HCL 25 MG TABLET ENALAPRIL MALEATE 5 MG TABLET HYDRALAZINE HCL 50 MG TABLET ENALAPRIL/HYDROCHLOROTHIAZIDE 10MG-25MG TABLET HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE ENALAPRIL/HYDROCHLOROTHIAZIDE 5MG-12.5MG TABLET HYDROCHLOROTHIAZIDE 12.5 MG TABLET FAMOTIDINE 20 MG TABLET HYDROCHLOROTHIAZIDE 25 MG TABLET FAMOTIDINE 40 MG TABLET HYDROCHLOROTHIAZIDE 50 MG TABLET

3 3 HYDROXYZINE HCL 10 MG TABLET LEVOTHYROXINE SODIUM 25 MCG TABLET HYDROXYZINE HCL 25 MG TABLET LEVOTHYROXINE SODIUM 300 MCG TABLET HYDROXYZINE HCL 50 MG TABLET LEVOTHYROXINE SODIUM 50 MCG TABLET HYDROXYZINE PAMOATE 25 MG CAPSULE LEVOTHYROXINE SODIUM 75 MCG TABLET HYDROXYZINE PAMOATE 50 MG CAPSULE LEVOTHYROXINE SODIUM 88 MCG TABLET IBUPROFEN 400 MG TABLET LISINOPRIL 10 MG TABLET IBUPROFEN 600 MG TABLET LISINOPRIL 2.5 MG TABLET IBUPROFEN 800 MG TABLET LISINOPRIL 20 MG TABLET IMIPRAMINE HCL 10 MG TABLET LISINOPRIL 30 MG TABLET IMIPRAMINE HCL 25 MG TABLET LISINOPRIL 40 MG TABLET IMIPRAMINE HCL 50 MG TABLET LISINOPRIL 5 MG TABLET INDOMETHACIN 25 MG CAPSULE LISINOPRIL/HYDROCHLOROTHIAZIDE MG TABLET INDOMETHACIN 50 MG CAPSULE LISINOPRIL/HYDROCHLOROTHIAZIDE MG TABLET ISONIAZID 300 MG TABLET LISINOPRIL/HYDROCHLOROTHIAZIDE 20-25MG TABLET ISOSORBIDE DINITRATE 10 MG TABLET LITHIUM CARBONATE 150 MG CAPSULE ISOSORBIDE DINITRATE 20 MG TABLET LITHIUM CARBONATE 300 MG CAPSULE ISOSORBIDE DINITRATE 30 MG TABLET LITHIUM CARBONATE 300 MG TABLET ISOSORBIDE DINITRATE 5 MG TABLET LITHIUM CARBONATE 300 MG TABLET ER ISOSORBIDE MONONITRATE 10 MG TABLET LITHIUM CARBONATE 450 MG TABLET ER ISOSORBIDE MONONITRATE 120 MG TAB ER 24H LITHIUM CARBONATE 600 MG CAPSULE ISOSORBIDE MONONITRATE 20 MG TABLET LORATADINE 10 MG TAB RAPDIS ISOSORBIDE MONONITRATE 30 MG TAB ER 24H LORATADINE 10 MG TABLET ISOSORBIDE MONONITRATE 60 MG TAB ER 24H LORATADINE 5 MG/5 ML SOLUTION LABETALOL HCL 100 MG TABLET LOSARTAN POTASSIUM 100 MG TABLET LABETALOL HCL 200 MG TABLET LOSARTAN POTASSIUM 25 MG TABLET LABETALOL HCL 300 MG TABLET LOSARTAN POTASSIUM 50 MG TABLET LAMOTRIGINE 100 MG TABLET LOSARTAN/HYDROCHLOROTHIAZIDE MG TABLET LAMOTRIGINE 150 MG TABLET LOSARTAN/HYDROCHLOROTHIAZIDE 100MG-25MG TABLET LAMOTRIGINE 200 MG TABLET LOSARTAN/HYDROCHLOROTHIAZIDE MG TABLET LAMOTRIGINE 25 MG TABLET LOVASTATIN 10 MG TABLET LAMOTRIGINE 25 MG TB CHW DSP LOVASTATIN 20 MG TABLET LAMOTRIGINE 5 MG TB CHW DSP LOVASTATIN 40 MG TABLET LEFLUNOMIDE 10 MG TABLET MECLIZINE HCL 12.5 MG TABLET LEFLUNOMIDE 20 MG TABLET MECLIZINE HCL 25 MG TABLET LETROZOLE 2.5 MG TABLET MELOXICAM 15 MG TABLET LEVETIRACETAM 100 MG/ML SOLUTION MELOXICAM 7.5 MG TABLET LEVETIRACETAM 1000 MG TABLET METFORMIN HCL 1000 MG TAB ER 24 LEVETIRACETAM 250 MG TABLET METFORMIN HCL 1000 MG TABLET LEVETIRACETAM 500 MG TAB ER 24H METFORMIN HCL 500 MG TAB ER 24H LEVETIRACETAM 500 MG TABLET METFORMIN HCL 500 MG TABLET LEVETIRACETAM 750 MG TAB ER 24H METFORMIN HCL 750 MG TAB ER 24H LEVETIRACETAM 750 MG TABLET METFORMIN HCL 850 MG TABLET LEVOCETIRIZINE DIHYDROCHLORIDE 5 MG TABLET METHOCARBAMOL 500 MG TABLET LEVOTHYROXINE SODIUM 100 MCG TABLET METHOCARBAMOL 750 MG TABLET LEVOTHYROXINE SODIUM 112 MCG TABLET METOCLOPRAMIDE HCL 10 MG TABLET LEVOTHYROXINE SODIUM 125 MCG TABLET METOCLOPRAMIDE HCL 5 MG TABLET LEVOTHYROXINE SODIUM 137 MCG TABLET METOPROLOL SUCCINATE 100 MG TAB ER 24H LEVOTHYROXINE SODIUM 150 MCG TABLET METOPROLOL SUCCINATE 200 MG TAB ER 24H LEVOTHYROXINE SODIUM 175MCG TABLET METOPROLOL SUCCINATE 25 MG TAB ER 24H LEVOTHYROXINE SODIUM 200 MCG TABLET METOPROLOL SUCCINATE 50 MG TAB ER 24H

4 4 METOPROLOL TARTRATE 100 MG TABLET OXCARBAZEPINE 300 MG TABLET METOPROLOL TARTRATE 25 MG TABLET OXCARBAZEPINE 600 MG TABLET METOPROLOL TARTRATE 50 MG TABLET OXYBUTYNIN CHLORIDE 5 MG TABLET MIRTAZAPINE 15 MG TABLET OXYBUTYNIN CHLORIDE 5 MG/5 ML SYRUP MIRTAZAPINE 30 MG TABLET PANTOPRAZOLE SODIUM 20 MG TABLET DR MIRTAZAPINE 45 MG TABLET PANTOPRAZOLE SODIUM 40 MG TABLET DR MIRTAZAPINE 7.5 MG TABLET PAROXETINE HCL 10 MG TABLET MOEXIPRIL HCL 15 MG TABLET PAROXETINE HCL 20 MG TABLET MOEXIPRIL HCL 7.5 MG TABLET PAROXETINE HCL 30 MG TABLET MOEXIPRIL/HYDROCHLOROTHIAZIDE MG TABLET PAROXETINE HCL 40 MG TABLET MOEXIPRIL/HYDROCHLOROTHIAZIDE 15-25MG TABLET PERINDOPRIL ERBUMINE 2 MG TABLET MOEXIPRIL/HYDROCHLOROTHIAZIDE MG TABLET PERINDOPRIL ERBUMINE 4 MG TABLET MONTELUKAST SODIUM 10 MG TABLET PERINDOPRIL ERBUMINE 8 MG TABLET MONTELUKAST SODIUM 4 MG TAB CHEW PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE MONTELUKAST SODIUM 5 MG TAB CHEW POTASSIUM CHLORIDE 10 MEQ TAB ER PRT MYCOPHENOLATE MOFETIL 250 MG CAPSULE POTASSIUM CHLORIDE 20 MEQ TAB ER PRT MYCOPHENOLATE MOFETIL 500 MG TABLET PRAMIPEXOLE DI-HCL MG TABLET NABUMETONE 500 MG TABLET PRAMIPEXOLE DI-HCL 0.25 MG TABLET NABUMETONE 750 MG TABLET PRAMIPEXOLE DI-HCL 0.5 MG TABLET NADOLOL 20 MG TABLET PRAMIPEXOLE DI-HCL 0.75 MG TABLET NADOLOL 40 MG TABLET PRAMIPEXOLE DI-HCL 1 MG TABLET NADOLOL 80 MG TABLET PRAMIPEXOLE DI-HCL 1.5 MG TABLET NAPROXEN 250 MG TABLET PRAVASTATIN SODIUM 10 MG TABLET NAPROXEN 375 MG TABLET PRAVASTATIN SODIUM 20 MG TABLET NAPROXEN 375 MG TABLET DR PRAVASTATIN SODIUM 40 MG TABLET NAPROXEN 500 MG TABLET PRAVASTATIN SODIUM 80 MG TABLET NAPROXEN 500 MG TABLET DR PRAZOSIN HCL 1 MG CAPSULE NAPROXEN SODIUM 275 MG TABLET PRAZOSIN HCL 2 MG CAPSULE NAPROXEN SODIUM 550 MG TABLET PRAZOSIN HCL 5 MG CAPSULE NIFEDIPINE 30 MG TAB ER 24 PRENATAL VITAMINS - GENERICS NIFEDIPINE 30 MG TABLET ER PROMETHAZINE HCL 12.5 MG TABLET NIFEDIPINE 60 MG TAB ER 24 PROMETHAZINE HCL 25 MG TABLET NIFEDIPINE 60 MG TABLET ER PROMETHAZINE HCL 50 MG TABLET NIFEDIPINE 90 MG TAB ER 24 PROPRANOLOL HCL 10 MG TABLET NIFEDIPINE 90 MG TABLET ER PROPRANOLOL HCL 120 MG CAP SA 24H NORTRIPTYLINE HCL 10 MG CAPSULE PROPRANOLOL HCL 160 MG CAP SA 24H NORTRIPTYLINE HCL 10 MG/5 ML SOLUTION PROPRANOLOL HCL 20 MG TABLET NORTRIPTYLINE HCL 25 MG CAPSULE PROPRANOLOL HCL 40 MG TABLET NORTRIPTYLINE HCL 75 MG CAPSULE PROPRANOLOL HCL 60 MG CAP SA 24H OLANZAPINE 10 MG TABLET PROPRANOLOL HCL 60 MG TABLET OLANZAPINE 15 MG TABLET PROPRANOLOL HCL 80 MG CAP SA 24H OLANZAPINE 2.5 MG TABLET PROPRANOLOL HCL 80 MG TABLET OLANZAPINE 20 MG TABLET QUETIAPINE FUMARATE 100 MG TABLET OLANZAPINE 5 MG TABLET QUETIAPINE FUMARATE 200 MG TABLET OLANZAPINE 7.5 MG TABLET QUETIAPINE FUMARATE 300 MG TABLET OMEPRAZOLE 10 MG CAPSULE DR QUETIAPINE FUMARATE 400 MG TABLET OMEPRAZOLE 20 MG CAPSULE DR QUINAPRIL HCL 10 MG TABLET OMEPRAZOLE 20 MG TABLET DR QUINAPRIL HCL 20 MG TABLET OMEPRAZOLE 40 MG CAPSULE DR QUINAPRIL HCL 40 MG TABLET OXCARBAZEPINE 150 MG TABLET QUINAPRIL HCL 5 MG TABLET

5 5 QUINAPRIL/HYDROCHLOROTHIAZIDE MG TABLET TERAZOSIN HCL 10 MG CAPSULE QUINAPRIL/HYDROCHLOROTHIAZIDE MG TABLET TERAZOSIN HCL 2 MG CAPSULE QUINAPRIL/HYDROCHLOROTHIAZIDE 20-25MG TABLET TERAZOSIN HCL 5 MG CAPSULE RAMIPRIL 1.25 MG CAPSULE TERBINAFINE HCL 250 MG TABLET RAMIPRIL 10 MG CAPSULE THEOPHYLLINE ANHYDROUS 100 MG TAB ER 12H RAMIPRIL 2.5 MG CAPSULE THEOPHYLLINE ANHYDROUS 200 MG TAB ER 12H RAMIPRIL 5 MG CAPSULE THEOPHYLLINE ANHYDROUS 300 MG TAB ER 12H RANITIDINE HCL 150 MG CAPSULE THEOPHYLLINE ANHYDROUS 450 MG TAB ER 12H RANITIDINE HCL 150 MG TABLET THIOTHIXENE 10 MG CAPSULE RANITIDINE HCL 300 MG CAPSULE THIOTHIXENE 2 MG CAPSULE RANITIDINE HCL 300 MG TABLET THIOTHIXENE 5 MG CAPSULE RISPERIDONE 0.25 MG TABLET TIZANIDINE HCL 2 MG TABLET RISPERIDONE 0.5 MG TABLET TIZANIDINE HCL 4 MG TABLET RISPERIDONE 1 MG TABLET TOPIRAMATE 100 MG TABLET RISPERIDONE 1 MG/ML SOLUTION TOPIRAMATE 200 MG TABLET RISPERIDONE 2 MG TABLET TOPIRAMATE 25 MG CAP SPRINK RISPERIDONE 3 MG TABLET TOPIRAMATE 25 MG TABLET RISPERIDONE 4 MG TABLET TOPIRAMATE 50 MG TABLET ROPINIROLE HCL 0.25 MG TABLET TORSEMIDE 10 MG TABLET ROPINIROLE HCL 0.5 MG TABLET TORSEMIDE 100 MG TABLET ROPINIROLE HCL 1 MG TABLET TORSEMIDE 20 MG TABLET ROPINIROLE HCL 2 MG TABLET TORSEMIDE 5 MG TABLET ROPINIROLE HCL 3 MG TABLET TRANDOLAPRIL 1 MG TABLET ROPINIROLE HCL 4 MG TABLET TRANDOLAPRIL 2 MG TABLET ROPINIROLE HCL 5 MG TABLET TRANDOLAPRIL 4 MG TABLET SERTRALINE HCL 100 MG TABLET TRAZODONE HCL 100 MG TABLET SERTRALINE HCL 20 MG/ML ORAL CONC TRAZODONE HCL 150 MG TABLET SERTRALINE HCL 25 MG TABLET TRAZODONE HCL 50 MG TABLET SERTRALINE HCL 50 MG TABLET TRIAMTERENE/HYDROCHLOROTHIAZID MG CAPSULE SIMVASTATIN 10 MG TABLET TRIAMTERENE/HYDROCHLOROTHIAZID MG TABLET SIMVASTATIN 20 MG TABLET TRIAMTERENE/HYDROCHLOROTHIAZID 75 MG-50MG TABLET SIMVASTATIN 40 MG TABLET TRIHEXYPHENIDYL HCL 2 MG TABLET SIMVASTATIN 5 MG TABLET TRIHEXYPHENIDYL HCL 5 MG TABLET SIMVASTATIN 80 MG TABLET URSODIOL 300 MG CAPSULE SODIUM FLUORIDE 0.5(1.1)MG TAB CHEW VALPROIC ACID 250 MG CAPSULE SOTALOL HCL 120 MG TABLET VENLAFAXINE HCL 100 MG TABLET SOTALOL HCL 160 MG TABLET VENLAFAXINE HCL 150 MG CAP ER 24H SOTALOL HCL 240 MG TABLET VENLAFAXINE HCL 25 MG TABLET SOTALOL HCL 80 MG TABLET VENLAFAXINE HCL 37.5 MG CAP ER 24H SPIRONOLACT/HYDROCHLOROTHIAZID 25 MG-25MG TABLET VENLAFAXINE HCL 37.5 MG TABLET SPIRONOLACTONE 100 MG TABLET VENLAFAXINE HCL 50 MG TABLET SPIRONOLACTONE 25 MG TABLET VENLAFAXINE HCL 75 MG CAP ER 24H SPIRONOLACTONE 50 MG TABLET VENLAFAXINE HCL 75 MG TABLET SUCRALFATE 1 G TABLET VERAPAMIL HCL 120 MG CAP24H PEL TACROLIMUS 0.5 MG CAPSULE VERAPAMIL HCL 120 MG TABLET TACROLIMUS 1 MG CAPSULE VERAPAMIL HCL 120 MG TABLET ER TAMOXIFEN CITRATE 10 MG TABLET VERAPAMIL HCL 180 MG CAP24H PEL TAMOXIFEN CITRATE 20 MG TABLET VERAPAMIL HCL 180 MG TABLET ER TAMSULOSIN HCL 0.4 MG CAP ER 24H VERAPAMIL HCL 240 MG CAP24H PEL TERAZOSIN HCL 1 MG CAPSULE VERAPAMIL HCL 240 MG TABLET ER

6 6 VERAPAMIL HCL 80 MG TABLET WARFARIN SODIUM 1 MG TABLET WARFARIN SODIUM 10 MG TABLET WARFARIN SODIUM 2 MG TABLET WARFARIN SODIUM 2.5 MG TABLET WARFARIN SODIUM 3 MG TABLET WARFARIN SODIUM 4 MG TABLET WARFARIN SODIUM 5 MG TABLET WARFARIN SODIUM 6 MG TABLET WARFARIN SODIUM 7.5 MG TABLET ZIPRASIDONE HCL 20 MG CAPSULE ZIPRASIDONE HCL 40 MG CAPSULE ZIPRASIDONE HCL 60 MG CAPSULE ZIPRASIDONE HCL 80 MG CAPSULE ZONISAMIDE 100 MG CAPSULE ZONISAMIDE 25 MG CAPSULE ZONISAMIDE 50 MG CAPSULE **Note: Oral Contraceptives, regardless of Brand/Generic status, may be dispensed in 6 month quantities if the total ingredient cost does not exceed $180 dollars for the six month quantity. For a list of oral contraceptive National Average Drug Acquisition Cost (NADAC) pricing, visit: